# ICFMR AT GEORGIA REGIONAL HOSPITAL ATLANTA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841328135
- **Authorized official:** SONNY SLATE COO (CHIEF OPERATION OFFICER)
- **Authorized official phone:** (404) 243-2121

## Contact information

- **Practice address:** 3073 PANTHERSVILLE ROAD, DECATUR, GA 30034-3828
- **Practice address phone:** (404) 243-2158
- **Practice address fax:** (404) 243-2159
- **Mailing address:** P.O. BOX 370407, DECATUR, GA 30034-3828
- **Mailing address phone:** (404) 243-2158
- **Mailing address fax:** (404) 243-2159

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | NULL | — |
| 315P00000X | Intellectual Disabilities Intermediate Care Facility | 2044856 | GA | Yes |

## Other

- **Enumeration date:** 03/01/2007
- **Last updated:** 08/18/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00141061A | — | GA |